Integrating the Healthcare Enterprise: a primer. Part 1. Introduction.

Does the subject of this series of articles intrigue you but you're not sure if the topics covered really apply to you and your practice? Before you read another word, go to the end of this introduction and seriously try to answer the questions posed there. If you answer "yes" to questions 1, 4, 5, 6, and 7, you need to read these articles.

Research and teaching access to a large clinical picture archiving and communication system.

PURPOSE: To identify practical issues surrounding delivering digital images from picture archiving and communication systems (PACS) for research and teaching purposes. The complexity of Digital Imaging and Communications in Medicine (DICOM) access methods, security, patient confidentiality, PACS database integrity, portability, and scalability are discussed. A software prototype designed to resolve these issues is described. SYSTEM ARCHITECTURE: A six-component, three-tier, client server software application program supporting DICOM query/retrieve services was developed in the JAWA language. This software was interfaced to a large GE (Mt Prospect, IL) Medical Systems clinical PACS at Northwestern Memorial Hospital (NMH). CONCLUSION: Images can be delivered from a clinical PACS for research and teaching purposes. Concerns for security, patient confidentiality, integrity of the PACS database, and management of the transactions can be addressed. The described software is one such solution for achieving this goal.

Primer on computers and information technology. Part two: an introduction to computer networking.

Computers networks are a way of connecting computers together such that they can exchange information. For this exchange to be successful, system behavior must be planned and specified very clearly at a number of different levels. Although there are many choices to be made at each level, often there are simple decisions that can be made to rapidly reduce the number of options. Planning is most important at the highest (application) and lowest (wiring) levels, whereas the middle levels must be specified to ensure compatibility. Because of the widespread use of the Internet, solutions based on Internet technologies are often cost-effective and should be considered when designing a network. As in all technical fields, consultation with experts (ie, computer networking specialists) may be worthwhile.

1995 Joseph E. Whitley, MD, Award. A World Wide Web gateway to the radiologic learning file.

RATIONALE AND OBJECTIVES: Computer networks in general, and the Internet specifically, are changing the way information is manipulated in the world at large and in radiology. The goal of this project was to develop a computer system in which images from the Radiologic Learning File, available previously only via a single-user laser disc, are made available over a generic, high-availability computer network to many potential users simultaneously. METHODS: Using a networked workstation in our laboratory and freely available distributed hypertext software, we established a World Wide Web (WWW) information server for radiology. Images from the Radiologic Learning File are requested through the WWW client software, digitized from a single laser disc containing the entire teaching file and then transmitted over the network to the client. The text accompanying each image is incorporated into the transmitted document. RESULTS: The Radiologic Learning File is now on-line, and requests to view the cases result in the delivery of the text and images. Image digitization via a frame grabber takes 1/30th of a second. Conversion of the image to a standard computer graphic format takes 45-60 sec. Text and image transmission speed on a local area network varies between 200 and 400 kilobytes (KB) per second depending on the network load. CONCLUSION: We have made images from a laser disc of the Radiologic Learning File available through an Internet-based hypertext server. The images previously available through a single-user system located in a remote section of our department are now ubiquitously available throughout our department via the department's computer network. We have thus converted a single-user, limited functionality system into a multiuser, widely available resource.

Development of the bi-directional ultrasound system for base of tongue imaging.

The use of conventional ultrasound systems to image the upper airway has been limited because ultrasound energy is attenuated by the air column. In an attempt to study upper airway geometry, we developed a computer controlled bi-directional ultrasound system which combines two conventional ultrasound devices with computer image processing to yield images of upper airway structures. Human studies and cadaver studies were performed to evaluate the system. Images acquired by the bi-directional ultrasound system were comparable to images from 3D volume rendered CT scans. This system may provide valuable data in the study of upper airway physiology and pathology.

The surgical workstation: surgical planning using generic software.

Computer software for rendering and display of three-dimensional data is becoming readily available for all types of computers. Such programs typically accept data from any source, compute a three-dimensional volume of data, and display it with a variety of rendering options. Although not specifically designed for medical image processing, these programs can provide very detailed and finely rendered images that are useful for surgical planning. We use one such program to display data from standard computed tomography scans, which gives us a photorealistic three-dimensional view of patient anatomy. This view can be modified to render tissues transparent, translucent, or opaque, and thus allows the surgeon to selectively enhance bony architecture, tumors, or other details. Images can be rotated, sliced, and displayed in the surgical position. Image animation can be added to facilitate the display of complex anatomic relationships. Our experience with this technology suggests that such programs can provide the basis for personal surgical workstations for medical image analysis and surgical planning. Further development of such generic imaging systems should allow this useful technology to become widely available for surgical planning and education. We discuss our experience with a typical generic imaging workstation.